Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT UPPER EXTRMTY W/CNTST BLTRL

Facility

$1,521.90

Service Code	HCPCS 73702
Hospital Charge Code	2205437
Hospital Revenue Code	352
Min. Negotiated Rate	$228.28
Max. Negotiated Rate	$228.28
Rate for Payer: Qualcare PPO/HMO/WC	$228.28

CT UPPER EXTRMTY W/CNTST BLTRL

Facility

$1,521.90

Service Code	HCPCS 73702
Hospital Charge Code	2205437
Hospital Revenue Code	352
Min. Negotiated Rate	$197.85
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$456.57
Rate for Payer: Aetna Medicare Advantage	$456.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.08
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.85
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$228.28
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT UPR XTRMTY W/&W/O CNST BLTL

Facility

$1,810.20

Service Code	HCPCS 73202
Hospital Charge Code	2205438
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT UPR XTRMTY W/&W/O CNST BLTL

Facility

$1,810.20

Service Code	HCPCS 73202
Hospital Charge Code	2205438
Hospital Revenue Code	352
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$543.06
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$233.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT UPR XTRMTY W/&W/O CNST RGHT

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205439
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT UPR XTRMTY W/&W/O CNST RGHT

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205439
Hospital Revenue Code	352
Min. Negotiated Rate	$553.92
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,278.27
Rate for Payer: Aetna Medicare Advantage	$1,278.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,086.53
Rate for Payer: Cigna Commercial	$2,130.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.92
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$639.13
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205443
Hospital Revenue Code	352
Min. Negotiated Rate	$461.98
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,066.11
Rate for Payer: Aetna Medicare Advantage	$1,066.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.19
Rate for Payer: Cigna Commercial	$1,776.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.98
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$533.05
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205443
Hospital Revenue Code	352
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$533.05
Rate for Payer: Qualcare PPO/HMO/WC	$533.05

CT WRIST W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205444
Hospital Revenue Code	352
Min. Negotiated Rate	$230.99
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$533.05
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.99
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205444
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT WRIST W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205445
Hospital Revenue Code	352
Min. Negotiated Rate	$230.99
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$533.05
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.99
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205445
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT WRIST W/O CONTRAST LEFT

Facility

$1,568.00

Service Code	HCPCS 73200LT
Hospital Charge Code	2205447
Hospital Revenue Code	352
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

CT WRIST W/O CONTRAST LEFT

Facility

$1,568.00

Service Code	HCPCS 73200LT
Hospital Charge Code	2205447
Hospital Revenue Code	352
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$470.40
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.84
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/O CONTRAST RIGHT

Facility

$1,568.00

Service Code	HCPCS 73200RT
Hospital Charge Code	2205448
Hospital Revenue Code	352
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

CT WRIST W/O CONTRAST RIGHT

Facility

$1,568.00

Service Code	HCPCS 73200RT
Hospital Charge Code	2205448
Hospital Revenue Code	352
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$470.40
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.84
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/&W/O CONTRAST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205440
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT WRIST W/&W/O CONTRAST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205440
Hospital Revenue Code	352
Min. Negotiated Rate	$553.92
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,278.27
Rate for Payer: Aetna Medicare Advantage	$1,278.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,086.53
Rate for Payer: Cigna Commercial	$2,130.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.92
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$639.13
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205441
Hospital Revenue Code	352
Min. Negotiated Rate	$276.96
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$639.13
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.96
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT WRIST W/&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205441
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT WRIST W/&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205442
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT WRIST W/&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205442
Hospital Revenue Code	352
Min. Negotiated Rate	$276.96
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$639.13
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.96
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CUBES CANCELLOUS 30CC

Facility

$2,809.65

Hospital Charge Code	270607538
Hospital Revenue Code	278
Min. Negotiated Rate	$421.45
Max. Negotiated Rate	$1,404.83
Rate for Payer: Aetna Commercial	$842.89
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$716.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$716.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$716.46
Rate for Payer: Cigna Commercial	$1,404.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.94
Rate for Payer: Qualcare PPO/HMO/WC	$421.45

CUBES CANCELLOUS 30CC

Facility

$2,809.65

Hospital Charge Code	270607538
Hospital Revenue Code	278
Min. Negotiated Rate	$421.45
Max. Negotiated Rate	$679.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.94
Rate for Payer: Qualcare PPO/HMO/WC	$421.45

CUBE TRUCK MDPE BLACK

Facility

$2,235.30

Hospital Charge Code	270689583
Hospital Revenue Code	272
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$1,117.65
Rate for Payer: Aetna Commercial	$670.59
Rate for Payer: Aetna Medicare Advantage	$670.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.00
Rate for Payer: Cigna Commercial	$1,117.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.59
Rate for Payer: Oxford Commercial	$1,117.65
Rate for Payer: Qualcare PPO/HMO/WC	$335.30
Rate for Payer: UnitedHealthcare Commercial	$1,117.65

Know your out-of-pocket cost for care.

All Charges